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General NPI Number Information
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NPI Number | 1609318112
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Entity Type | Organization
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Legal Business Name | ROOTS & WINGS COMMUNITY CHARTER SCHOOL
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 35 LA LAMA ROAD
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City | ALBUQUERQUE
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State | NM
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Zip | 87556
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Country | US
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Telephone | 575-585-2076
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Fax | 575-586-2087
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Provider Business Mailing Address
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Address Line | HC 81, P.O. BOX 22 35 LA LAMA ROAD
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City | ALBUQUERQUE
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State | NM
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Zip | 87556
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Country | US
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Telephone | 575-585-2076
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Fax | 575-586-2087
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Authorized Official
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Title or Position | BUSINESS MANAGER/CPO
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Name | CHARLOTTE M ARCHULETA
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Credential |
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Telephone | 505-450-1415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 000T6366
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License Number State | NM
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